Insights from HCEG Thought Leaders

This is the final post of a 3-part series sharing physician perspectives on COVID-19 impact on the fall season. The information, insight, and ideas presented in this series originated from an informal discussion Ferris Taylor of the HealthCare Executive Group had with three physician executives:

HCEG board member Dr. David Diloreto, MD, a board-certified ophthalmologist, ophthalmic plastic surgeon, a principal at Vizient/Sg2 and prior senior vice-president at GE Healthcare Camden was joined by:

Dr. Johanna Vidal-Phelan, MD, Senior Medical Director in Pediatrics at the University of Pittsburgh Medical Center Health Plan and a practicing pediatrician at Hamilton Health Center, an FQHC in Harrisburg, PA and

Dr. Jason Woo, MD a practicing board-certified obstetrician/gynecologist, a veteran with 31 years in the Commissioned Corps of the U.S. Public Health Service and a consultant at the Arbinger Institute.

COVID-19 Impact to Healthcare: Topics Discussed in This Series

The trio of physician executives discussed the following topics in the first and second posts of the series:

Part 1 Topics

Part 2 Topics

– Impact Factors Affecting Utilization of Services – Balancing Treatment to Avoid Ongoing Destruction of Demand for Non-COVID Services – Returning to School & Addressing Disadvantaged Populations – A Pediatric Physician on Sending Kids – Including Her Own – Back to School – Impacts on Minorities & Underserved Populations – Uncertainty in Testing and Understanding Prevalence – How Long Will We Be Dealing with COVID-19?

– COVID-10 Vaccines & Importance of Fall Flu Shots – Avoiding Other Illnesses or a Different Pandemic – Maintain Immunizations – Vaccinations for Underserved Populations – Messaging is Key – The Change to Telehealth: New Opportunities for Providers to Connect with Patients – Rethinking the Healthcare Supply-Chain – PPE as a Matter of Trust

Listen to the entire recording here

Be sure to subscribe to our newsletter for more information of potential value to healthcare leaders and change-makers.

Live, Interactive Chat and Q&A – October 13th, 2020

On Tuesday, October 13, 2020, at 11:00 am PT/2:00 pm ET, Doctors DiLoreto, Vidal-Phelan, and Woo will present additional details and current insight on what can be expected for the coming fall season under COVID-19.

Join us for a live, interactive discussion and Q&A. Questions and requests for additional information shared by registrants prior to and/or during the live chat will be fielded by the panelists. Reserve your seat and submit your questions and comments today!

Lessons Learned and Lessons to Be Learned

Lessons learned during the coronavirus pandemic can help to drive innovation that transforms preparedness, care delivery, quality, safety, efficiency, and patient experience over the coming months and years. The discussion continued with the physicians sharing some lessons learned and lessons to be learned.

Experiences from Southern Hemisphere – Seasonal Viruses at All-Time Lows

Dr. David:

“We’re also working with folks in the southern hemisphere right now. It’s very interesting they’re in the depths of winter in the southern hemisphere. The pandemic is certainly spreading and hitting places very hard; whether it’s Melbourne Australia, Santiago Chile, Johannesburg South Africa.

What’s interesting is that the incidence of other seasonal viruses is at an all-time low – historic lows. And it’s across a long spectrum so influenza, RSV, pneumococcus remains extraordinarily low suggesting that, obviously, measures such as social distancing, mask-wearing, hand washing are going to be more important than ever. And obviously vaccinating against flu and pneumococcus for older patients is going to be important.

Hopefully in North America, as we enter into winter, we’ll get similar effects that will suppress – like we did in the spring – some of the seasonal virus activity.”

Value of Encouraging Use of Masks

Dr. Johanna:

“And I think one important point about this is mask-wearing. And so, for example, places like Australia you just mentioned. In Chile, people are being compliant with using masks. So this is a message that we really need to also share with our community and the population that wearing your mask is important not only for COVID-19 but it does prevent the exposure to other viruses and illnesses.

And that I tell my pediatric patients wearing your masses showing your love is caring and so they do it, they do it very well.”

RELATED: Surviving Coronavirus Pandemic & Thriving on the Other Side: Rapid Innovation & Telehealth

‘Long Haulers’ – The Unknown, Long-Term Impact of COVID-19

Dr. David Diloreto:

“I’d like to get your insights into are some of the issues we’re seeing with long haulers – folks who actually are continuing to demonstrate symptoms, troubling symptoms, for many weeks or months and potentially for some of them it could be long term.

We’re seeing widespread neurologic complications, cardiovascular complications – obviously there are aspects of this disease we don’t quite fully understand.”

Dr. David prompted fellow panelists to share a little bit about their concerns in younger individuals who may have had minimal symptomatology but have persistent symptoms going forward that don’t seem to be resolving.

Dr. Jason responded:

“One of the challenges is that when folks say “oh, this is a hoax or this is not real,” I think part of it is just recognizing what they’re seeing right and then what’s relevant to them. The challenge is when we have all this uncertainty when we have so many different messages, and there are all these aspects about the COVID-19 virus and its pathology in the body.

We are only beginning to get a sense that folks aren’t dying from pneumonia, they’re dying from micro infarctions throughout their lungs where it’s overwhelming the immune response. That’s killing them not the typical virus reproduction. And then the neurologic symptoms and the muscle symptoms where the virus is infecting whole body systems.

COVID-19 and Its Uncertain Pathology

We just have no knowledge of that. So, when folks see things it’s recognizing there’s still a lot of uncertainty about this. What’s right for you is what is going to be right for you. But do you want to do that in a vacuum or do you want to do that with better information? So how do we help better inform you about what those risks are because we know that the data is constantly evolving?

And how do we help you be alive for that so that we’re working together to figure it out because one person going back to work by themselves is not going to fix the economy? It’s how do we do this together and how do we address all the different concerns that people are going to be having – be it their economic ones or if they’re elder parents there are long-term consequences for the individual. How do we be alive to the things that are the highest priority for them in terms of what’s the information that they need to make a better decision?”

RELATED: COVID-19 Resources for Health Plans, Health Systems, & Medical Service Providers

Financial Impact on Providers, Employer Groups, & Payers

The coronavirus pandemic has had a significant negative impact to the financial status of hospitals, physicians in private practice, and physicians employed by health systems. With patient volumes cut 60% or worse and with so many healthcare providers paid based on volume, many physicians have taken unprecedented hits to their revenue, and many organizations have furloughed or laid-off employees.

Dr. David shared how the coronavirus pandemic has likely forced all stakeholders – providers, employer groups, and payers including federal and state healthcare programs like Medicaid – into pursuing new value-based reimbursement models.

Employers Forced into New Reimbursement Models

“And employers who are really not that interested in thinking about value-based care – they just wanted to make sure their employees were happy with health insurance – now are looking at all kinds of – and these are small and medium-sized employers – anything they can do to eliminate costs now.

They’re much more interested in episode of care bundles and basically looking at structural reimbursement models that deliver their risk going forward. So our projections are that we (as individuals) and obviously state governments have been shielded to some degree from the economic impact by federal subsidies.

But if the economy is shut down in certain states and the tax base erodes, they’re going to have to look at their Medicaid programs in about 18 months totally differently. So there’s going to be much more cost reduction in that space.”

RELATED: Modifying the Focus of Medicaid Value-Based Payment in the Context of COVID-19

Delayed Demand for Non-COVID Services

“So the folks that are also interesting to me are payers. If you look at what’s happened in 2020, many of them obviously – with the demand destruction – now are actually looking at significant surpluses on their financials for 2020. And they’re trying to really look at certain reserving capabilities including a reserve I never knew that existed called the premium discount reserve.

But it’s a way, in this instance, of being able to move these positive income statement effects off your books and onto your balance sheet and release it in future periods. But anyway, that’s probably not for this group.”

COVID-19 Forcing Physicians to Reevaluate Reimbursement

Dr. Jason Woo asked Dr. David Diloreto how the shift in the reimbursement payment system is going to affect our ability to be able to be more comprehensive in our coverage of the population?

Dr. David Diloreto responded:

“This is one of the most interesting aspects that for almost all of my clinical career, which is 30 years now, physicians generally viewed the least risky way to get paid was on a service basis. What’s really interesting is right now in large physician groups and in single-specialty groups and health system employee groups many specialists are thinking differently. They’ve been in situations now that seen demand from elective procedures (drop significantly) and they’re worried about the future.

If you can imagine being a bariatric surgeon with a large mortgage and trying to save money for college education, the world change doesn’t look like the world is going to come back that way. So they’re having grown-up discussions about changing the reimbursement models more to deliver that risk by going to employment; to going to safer ways of getting paid including fixed fees.”

Supporting & Caring for Front-Line Providers

In addition to financial impacts which were discussed later in the session, the physician panelists shared how the coronavirus pandemic has placed a huge physical and emotional burden on many frontline providers. Ferris prompted the physician panelists to share their thoughts on this quadrant of the Quadruple Aim:

What would be effective measures to decrease the burnout rate of physicians and everyone else fighting the coronavirus pandemic?

Dr. Jason:

“I think that in a lot of ways it’s going to be very healthy for health care providers to be able to connect to their patient’s. I think on the other side, those frontline providers that are still stuck with trying to take care of the folks that are coming through the ER or into the ICU is where there’s still not a lot of good information. And the struggle that they’re going to go through of trying to do the best that they can with all the uncertainty in the limitations that we have. I think for those folks we have to be really mindful that there’s a great burden that our traditional thought about what the role of the provider is. We have to help see beyond right and get into that.

What’s the best that you can do? What is not the best outcome that you’re going to be able to get, wish for every patient, but what’s the best that you can do within your circumstances. And being more for more mindful of the limitations that your role is going to be, that it is going to have. I think it’s hard because be it the lack of the supply chain, the lack of PPE, the challenges of what tests are available, or not available. Until that gets standardized, until there’s been able to get some trust in the data that they have and the testing methods that they, and the treatments available it’s just going to be hard to be a frontline provider.”

Dr. David added

“I think what we do need to get is the impact on providers, front line providers, who have been through the ringer. If you just think about what they’ve had to do throughout the spring into the summer – even in outpatient practices. Now all the PPE requirements on and off; all the changes in your practice; this is really taking a toll on providers right now.”

Get Your COVID-19 Questions Answered on October 13th

The discussion ended with a general agreement that the discussion could go on for hours. Accordingly, the three physicians agreed to make themselves available for a live, interactive follow-on chat with a Q & A opportunity on October 13, 2020 at 11:00 am PT / 2:00 pm ET.

Reserve your seat and submit your questions and comments today!

Be sure to take advantage of this unique opportunity to learn more about what’s presented in this post – and please share it with your associates. And if you are not a subscriber to our newsletter, consider joining 5000+ other healthcare leaders, change-makers, and industry participants and subscribe today!

Late last month, the HealthCare Executive Group hosted an informal discussion with three physician executives on their observations, experiences, and insight about how COVID-19 has impacted healthcare and healthcare stakeholders. The theme of the discussion was: “What’s changed, what’s remained the same, and what can we expect in the coming fall season?”

HCEG board member Dr. David Diloreto, MD, a board-certified ophthalmologist, ophthalmic plastic surgeon, a principal at Vizient/Sg2 and prior senior vice-president at GE Healthcare Camden was joined by:

Dr. Johanna Vidal-Phelan, MD, Senior Medical Director in Pediatrics at the University of Pittsburgh Medical Center Health Plan and a practicing pediatrician at Hamilton Health Center, an FQHC in Harrisburg, PA and Dr. Jason Woo, MD a practicing board-certified obstetrician/gynecologist, a veteran with 31 years in the Commissioned Corps of the U.S. Public Health Service and a consultant at the Arbinger Institute.

HCEG’s Executive Director Ferris Taylor helped to facilitate the discussion and provided an HCEG perspective.

This is the second post of a three-part series sharing highlights of that conversation. See the first part here and consider subscribing to our newsletter to receive the final post and other information of value to healthcare leaders and change-makers.

Topics Discussed in Part 1

The trio of physician executives discussed the following topics in the first post of this series:

• Impact Factors Affecting Utilization of Services
• Balancing Treatment to Avoid Ongoing Destruction of Demand for Non-COVID Services
• Returning to School & Addressing Disadvantaged Populations
• A Pediatric Physician on Sending Kids – Including Her Own – Back to School
• Impacts on Minorities & Underserved Populations
• Uncertainty in Testing and Understanding Prevalence
• How Long Will We Be Dealing with COVID-19?

Listen to the entire recording here

Live, Interactive Follow-On Chat and Q&A – October 13^th

For more detailed information on the topics presented in this series of posts and for a chance to interact with and ask questions of these physician leaders, join us on October 13, 2020 at 11:00am PT/2:00 pm ET for a live, interactive chat. The physician panelists will provide additional insight on what’s changed, what’s remained, and what can be expected for the coming fall and winter season under COVID-19.

Questions and requests for additional information shared by registrants prior to and/or during the live chat will be fielded by the panelists. Reserve your seat and submit your questions and comments today!Be sure to take advantage of this unique opportunity to learn more about what’s presented in this post – and please share it with your associates.

COVID-19 Vaccines & Fall Flu Shots

A significant part of the discussion continued on the development of a COVID vaccine and the importance of getting a seasonal flu shot to avoid undue burden to services and potential mis-diagnoses of the seasonal flu as COVID-19. Dr. Johanna shared:

Importance of Flu Shots – Minimize Avoidable Impacts

“We saw a decline of seasonal viruses during the spring and early beginning of the summer. I think right now you have to think about the monumental impact of children returning to school even if it’s for two days. Our children (Dr. Johanna’s children) have been with us since March 13th at 4 p.m. when the school released them and said ‘They’re not coming back. We don’t know when.’

 And so our children haven’t really been exposed to a lot of other people, so we do know that children are going to be exposed not only to COVID-19 but all the other normal viruses that we see; or bacteria like strep throat. I think one of the important messages that I’ve been sharing with my family since day one is the importance of the flu vaccine. And there is a lot of misinformation and misunderstanding about the flu vaccine. People still believe that you get sick from the flu vaccine. That you are going to develop the flu from the flu vaccine. A lot of families, almost not even 50 % of the population in the United States, do not get the flu vaccine every year. “

Is Herd Immunity a Potential Solution?

Dr. Johanna continued:

“And so if we want to have a good herd immunity, it is important and I explained to the parents, that providing the flu vaccine to your child and your family is a way to combat a coronavirus. And they look at me like ‘Why? It’s a different virus.’

 And I said: ‘because when your child gets sick with the flu, because you didn’t want to get the flu shot, we are going to have a very hard time differentiating between COVID-19 or the flu. So we have to test your child for both viruses and then there’s going to create a level of anxiety regarding school, quarantine and care that your child is going to need because we don’t know if it’s the flu.’”

Avoiding Other Illnesses or a Different Pandemic – Maintain Immunizations

“Now you can get the flu after getting the flu vaccine but you’re going to be protected from some of the major complications that we see when you have a natural illness and the duration of the illness is much shorter instead of being two to three weeks with the natural illness, it may be two to three days.

So I explained to the parents the importance of getting all the children’s immunizations on time. And believe it or not, there’s a critical important piece of information I need families to understand: Even though throughout most of COVID-19 pediatricians are open and family doctors are seeing children too, the importance of the well-child visit to be up-to-date and your teenagers, and the shots is critical – because we don’t want to change this pandemic for a measles epidemic or whooping cough so we have vaccines to prevent illnesses so let’s use them, let’s get them.”

Vaccinations for Underserved Populations – Messaging is Key

Dr. Jason shared the importance of reaching out to underserved populations is a trustful manner:

“I think there’s a communication point that has to be addressed- particularly for the underprivileged populations – is that getting vaccinations has to come from people who sound and look like them. It cannot come from the systems. And that’s where engaging your community outreach folks is going to be so critical to be able to get those. And it may not be having them coming to the hospital. It may be having the local pharmacy or having folks who are able to engage them there.

Because just as you point out Johanna, there’s so much mistrust and particularly folks are just when you can put the message through a medium that they’re more comfortable with that’s just going to be that’s so critical to address some of the social determinants that inhibit a lot of our understanding.”

Dr. David added:

“And that’s encouraging because it’s going to be needed coming forward. CVS for instance has 1800 testing sites right now around the United States that they’re expanding and they’re in negotiations to become vaccination centers. So just to your point that the neighborhood drug store being actually now a health hub where you can get vaccinated.”

RELATED: Surviving Coronavirus Pandemic & Thriving on the Other Side: Rapid Innovation & Telehealth

The Change to Telehealth

One of the clear changes instigated by the coronavirus pandemic is the rapid adoption of telehealth. Stay-at-home and physical-distancing directives forced providers to rapidly adopt telehealth services or expand existing telehealth capabilities. Long hampered by reimbursement and physician adoption challenges, telehealth use exploded at the end of the 1^st quarter of 2022 and has now become table-stakes.

Ferris prompted the panelists to share their take on telehealth and Dr. Johanna began:

Physicians Warming to Telehealth

“So I definitely also want to emphasize the importance of innovation and technology. I would talk to peers six months ago if somebody was telling me that I was going to do a tele-visit. I would have left. I was like: ‘I cannot see a pediatric patient by computer or phone.’

And now is I love it. And definitely it has pushed innovation into healthcare. It was slowly happening but to go from March to April and to see the dramatic jump into utilization of telemedicine is really important because it’s being used as a tool to connect with families; to engage patients; to continue allowing providers and physicians to continue providing the services that they (patients) need, and that is part of value-based care.”

Dr. Johanna urged physicians to answer the question:

“How can you think outside of the box in order to reach the population that is yours in order to prove it provides the best outcome for your patients?

And offered a reminder:

“And so the traditional model is one-to-one, in the office, with the physician. And we’re moving away from that model to having health care done in the home environment, remote monitoring, telemedicine, community health workers, other alternative sites of care – in order to complement what we call traditional medicine.”

Telehealth – New Opportunities for Providers to Connect with Patients

Dr. Jason on opportunities for telehealth: elective vs. non-elective procedures

“I think there are two different populations of providers that we need to think about:

1. Elective Procedures – Non-Emergent

“One is the folks who perform more of the elective stuff who are not the frontline workers now. In the sense that David was talking about, the folks who traditionally may have been doing elective surgeries or other sub-specialty care where there is an opportunity to transform the way they’re delivering care. In a way, I think that’s going to be more effective because of the opportunity to accept a lot of the modalities that telehealth has pushed forward.

I’ve been trying to do telehealth 20 years ago. I was trying to push telehealth in. I saw the radiologists, the mental health, and the psychiatrist, they loved it because there’s just so much more opportunity available to them when they’re not one-on-one in a fixed location anymore. And for those folks, I think there’s an opportunity to get back to actually better outcomes; to connect with your patients in a way that you hadn’t before.

It’s kind of like Zoom. We do a lot of training and I love the chat feature because there’s this ability to interact with folks that I hadn’t thought of before. And when you’re open to that I think that, in a lot of ways, it’s going to be very healthy for healthcare providers to be able to connect to the patients.”

RELATED: Should You Go to the Doctor’s Office During Covid-19?

2. Non-Elective Procedures – Emergent

“I think on the other side though is those frontline providers that are still stuck with trying to take care of the folks that are coming through the ER or into their ICU’S; where there’s still not a lot of good information. And the struggle that they’re going to go through of trying to do the best that they can with all the uncertainty and the limitations that we have.

I think for those folks we have to be really mindful that there’s a great burden that our traditional thought about what the role of the provider is that we as a physician, I think, we have to help (our patients) see beyond and get into ‘What’s the best that you can do?’”

Healthcare Supply-Chain – Rethinking COVID-19 Impacts

The ready availability of PPE, medical equipment like ventilators, and certain pharmaceuticals was clearly called into question by the coronavirus pandemic. The lack of a $3.00 mask hampered providers’ ability to serve patients. And $30,000 ventilators are not just easily stocked without serious consideration.

Availability of Personal Protective Equipment – A Matter of Trust

Dr. Johanna shared her personal perspective from previous pandemics:

“I remember H1N1 and it was not like this. There is an element of trust as a provider, and also as a person working in the United States, that I should have not had to worry about where is my PPE coming from. It never crossed my mind in 2009 that I would not have enough PPE to protect myself against H1N1.

 And if you recall, pregnant women were high risk for H1N1. And I was pregnant, caring for pediatric patients, with my second child and I never had to think about it twice. And so now, it’s the anxiety that providers have to know that they’re having the correct equipment in order to provide the care.

 And also knowing so many of our peers are impacted by this disease and have died. It’s something that you need to pause and think about: What are we doing?”

Physician’s New Understanding & Appreciation for Supply Chains

Dr. David on physicians and their supply-chain relationship:

“The other interesting difference is that most physicians in December of last year (2019) probably couldn’t really describe a supply chain and certainly couldn’t talk to you about the strategic value of a supply chain.

Well, after they went through the PPE shortages and pharmacy shortages, they’re now really interested in working with their healthcare stakeholders and hospital stakeholders on how to optimize supply chain activities.

And so there’s a lot of work around nationalizing and onshoring. One of the shortages in the supply chain is the fact that countries nationalize these products, they’re not coming to North America. We’re having to work through that and that’s a big change. So with respect to payment models, we’re already seeing employers – remember there’s going to be some significant economic issues for companies/employers who are not interested in or thinking about value-based care.”

RELATED: With Excess National Supply, Exchanges Will Allow U.S. Hospitals to Continue Meeting Ventilator Demand

Part 3 Coming Soon – More COVID-19 Insight from Physician Executives

In the final post of this three-part series, highlights and details on the following topics from the informal discussion with Dr. Diloreto, Dr. Johanna Vidal-Phelan, and Dr. Jason Woo will be shared:

• Lessons Learned and Lessons to Be Learned
• Experiences from Southern Hemisphere – Seasonal Viruses at All-Time Lows
• Value of Encouraging Use of Masks
• ‘Long Haulers’ – The Unknown, Long-Term Impact of COVID-19
• Financial Impact on Providers, Employer Groups, & Payers
• Employers Forced into New Reimbursement Models
• Delayed Demand for Non-COVID Services

Live, Interactive Follow-On Chat and Q & A – October 13th

For more detailed information on the topics raised in this series of posts and for a chance to interact with and ask questions of these physician executives, join us on October 13, 2020, at 11:00 am PT/2:00 pm ET for a live, interactive follow-on chat and Q & A opportunity.

The physician panelists will provide additional insight into what’s changed, what’s remained the same, and what may be expected this fall and going into 2021. Questions and requests for additional information shared by registrants prior to and/or during the live chat will be fielded by the panelists.

Reserve your seat and submit your questions and comments today!Be sure to take advantage of this unique opportunity to learn more about what’s presented in this post – and please share it with your associates. And if you are not a subscriber to our newsletter, consider joining 5000+ other healthcare leaders, change-makers, and industry participants and subscribe today!

The coronavirus pandemic has changed the world dramatically. Since late February, healthcare organizations have been largely in crisis mode – adapting to new testing and treatment demands and strategies – all while struggling to stay afloat emotionally, physically, and financially during these difficult times.

• They’re dealing with supply chain challenges.
• They’re adopting telehealth or accelerating their existing use of virtual health services.
• They’re dealing with financial uncertainties due to either their focus on COVID-19 or due to the destruction of demand for non-COVID related services.
• They’re navigating the harsh reality of a reimbursement system based on volume.

And there are many other changes caused by the pandemic and the response to the pandemic that are not yet known or fully understood.

And now, our school systems are struggling to safely re-open and bring some semblance of normality back to families and children. And as autumn rapidly approaches, addressing concerns about the potential impact from kids returning to school and the fall flu season are topics of discussion among many people.So what’s changed and what’s remained the same? What have healthcare leaders – particularly those serving in clinical and public health roles – observed and learned over the past months? What challenges, issues, and opportunities should they be focusing on? Is there a yin-yang opportunity available?

COVID-19 Insight, Information, & Ideas from Physician Leaders

To help answer these questions, the HealthCare Executive Group hosted an informal discussion with three physician executives. This post, the first in a series of three, shares some highlights and some details from that discussion.

Look for the remaining posts over the coming weeks and be sure to subscribe to our newsletter for more information on potential value to healthcare leaders and change-makers.

Listen to the entire recording here

Physician Leader Panelists

Long-time HCEG board member Dr. David Diloreto, MD, a board-certified ophthalmologist, ophthalmic plastic surgeon, currently a principal at Vizient/Sg2 and prior senior vice-president at GE Healthcare Camden was joined by Dr. Johanna Vidal-Phelan, MD and Dr. Jason Woo, MD.

Dr. David Diloreto, MD	Dr. Johanna Vidal-Phelan	Dr. Jason Woo, MD

Dr. Johanna Vidal-Phelan, MD (Dr. Johanna) is Senior Medical Director in Pediatrics at the University of Pittsburgh Medical Center Health Plan and a practicing pediatrician at Hamilton Health Center, an FQHC in Harrisburg, PA.

Dr. Jason Woo, MD (Dr. Jason) is a practicing board-certified obstetrician/gynecologist and a veteran with 31 years in the Commissioned Corps of the U.S. Public Health Service. Dr. Woo is a consultant at the Arbinger Institute.

In addition, HCEG’s Executive Director Ferris Taylor helped to facilitate the discussion and provide HCEG perspectives. For more on the background and expertise of these participant leaders, see their bios here.

Live, Interactive Follow-On Chat and Q & A – October 13th

For more detailed information on the topics raised in this series of posts and for a chance to interact with and ask questions of these physicians, join us on October 13, 2020, at 11:00 am PT/2:00 pm ET for a live, interactive follow-on chat and Q & A opportunity.

The physician panelists will provide additional insight on what’s changed and what’s remained the same under COVID-19 with more on what expect this fall and going into 2021.

Questions and requests for additional information shared by registrants prior to and/or during the live chat will be fielded by the panelists. Reserve your seat and submit your questions and comments today!Be sure to take advantage of this unique opportunity to learn more about what’s presented in this post – and please share it with your associates.

Discussion Kickoff

Ferris Taylor welcomed everyone, offered a short summary of the goals of the informal discussion and passed the microphone (virtually of course) to Dr. Diloreto to kick off the discussion by sharing some information and insight collected over the last six months.

Physician Executives on COVID-19 Over the Last Six Months

“Supply chain issues this spring and the PPE and pharmaceutical shortages have presented new challenges, issues, and opportunities to analytics companies; re-doing their algorithms to account for co-covered impact factors.

Results of market demand forecasting and essentially what we’re seeing is a lot of what we have been virtual health. we’ve been we’ve probably compressed the trend for adoption of virtual health by five to seven years and now people are figuring out well that was bootstrapping and video conferencing with families but how do we really get the provider workflows adjusted so that this is meaningful and a productive way to deliver care.”

Impact Factors Affecting Utilization of Services

“The other thing we’re looking at that’s interesting is how the impact factors are affecting utilization of services. Early on we saw folks just avoiding the emergency room even staying home with symptoms of stroke and myocardial infarction. The high acuity services have returned but low acuity services have not, and we don’t believe they ever will.

These are things that basically probably shouldn’t have been in the emergency room to start with and folks are finding ways to deal with it. High acuity conditions like TAVR (Transcutaneous Aortic Valve Replacement) procedures and neurosurgical procedures are actually coming back really strong. People almost at full comparing the first six months of 2019 the first six months of 2020 basically the same utilization rates.

What’s interesting are more elective procedures including things like PE tubes in children – which have only come back to about 40 %. And so one of the issues there is could be a combination of factors. In the social distancing that was happening in the spring maybe there was less UTI and eye infections. On the other hand, families that we know are avoiding preventive services. There may be children with chronic ear infections not getting detected now. There are things that may play out long term that we have to figure out. So there’s a variable return of on the provider side of certain services.”

Dr. David went on to share more about:

Balancing Treatment to Avoid Ongoing Destruction of Demand for Non-COVID Services

1. They have to balance the treatment of COVID positive patients and non-COVID positive patients in the pandemic. And we watch those surges in places like Tampa and Los Angeles and Houston last month. And actually the provider community is getting a lot better at being able to balance that care. We know more about early intervention with certain treatments. There’s less folks going on onto ventilators and obviously we’re protecting the most vulnerable people in the elderly and institutions much better. 

2. On the other hand, the impacts financially both from demand destruction as well as increased costs are huge. We’re seeing provider groups, hospitals and health systems really having to deal now with not only the near-term financial recovery but also some very significant economic issues. We’re looking at unemployment rates in Florida right now and in Orlando where there’s high rates of people employed in tourism and entry-level service jobs unemployment rate of about 20%.

Returning to School & Addressing Disadvantaged Populations

1. Should I send my children to school? What should I look for? Am I at risk? How will they (children) interact with aunts and uncles and grandparents? Is it really safe? And if they don’t go to school, what does that mean? 

2. The impact in disadvantaged communities has been huge and it plays out in interesting ways not just in urban centers but was really interesting as we watched the surges in Los Angeles, Tampa and Houston as they came down the nearby rural areas particularly where you had either migrant workers and low-income workers in fields they were getting infected at very high rates. That’s probably sort of the fits and starts with this that we’re going to have throughout this pandemic until there’s widespread use of vaccines, herd immunity and more effective therapies

A Pediatrician on Sending Kids – Including Her Own – Back to School

Dr. Johanna was asked: What are you advising your patients on when they ask you: “Is it safe to send someone to school? As both a Practicing pediatrician and a parent of two school aged children, Johanna shared:

“So that’s a very important question and each family will have a different solution. I think that the first thing I have to tell parents and including myself as a parent is to empower the parent to make the decision. And there’s no wrong or right decision. You need to do what’s right for your family. And so, in partnership with the school district where your children are, I’m going to think about different things that had happened in the last 10 years for families and children. This has been one of those aspects that had created a lot of anxiety for families including myself. And I think a topic of importance to discuss is in regard to the home environment. 

Most of the kids in the state of Pennsylvania are not having the opportunity to return to school full-time – so not five days. They’re doing a hybrid model or fully online. What is the impact for a working family that has to figure out how to come up with new solutions in regard to the care of the children during the days that they are not in school?”

Impacts to Minorities & Underserved Populations

“And the financial hardship that that may represent to a family. I’ve seen families make very challenging decisions where one of the parents is no longer working. So that parent can help with the children in the home environment for schooling. And other families are sending their children though they don’t want to, or they don’t feel comfortable because they have to go to work. I’ve seen a really dramatic impact in Latinos and minorities. As you know, Latino families/minorities families are mainly in the service industry – many of us. So what happens is that the level of exposure to COVID-19 is higher – disproportionately impacting African Americans and Latinos. 

So you think about families and the impact in children and what that means to them is significant. It is a very challenging question. Parents ask me all the time in the pediatric practice and I respond with the answer: What is it that is important to you as a family? What is it that you can provide or not for your children education? And then we have a frank discussion about what the family will need to do.”

Uncertainty in Testing & Understanding Prevalence

Dr. Jason followed on with:

“I think, coming from the public health perspective particularly the FDA background, there’s just so much uncertainty in the testing and understanding incidents prevalence and what the outcome of an infection is. It’s so critical to be non-judgmental of what – as you pointed out Johanna – each family has to figure out what’s best for them. 

As we’re providing services, part of the challenge is to be aware of the individuality that has to be accounted for each of the patients or each of the patients coming or families coming into the healthcare system and trying to figure out what’s right for them.”

A Perfect Petri “Diamond Princess” Dish – Wasted

“I think the one thing I kicked myself is, at the beginning of all this, I was so certain that we would have such good data from the date of the Diamond Princess. There were 3000 patients, they’ve been isolated, they’re dropping CDC resources in there, they’re doing sampling and we’re going to have so much information. And then after two weeks and nothing’s coming out. I had completely missed out. 

We talk about the public health system being underfunded but I never expected us to be so poorly informed in terms of the data of the natural course of the infection, of infectivity, of how quickly it spreads and how it spreads. And so now with the plethora of different testing and the different way things are being approved by the FDA, I think it’s challenging because it’s just not the kind of data or standards that we would have had when we did Ebola, when we did Zika. 

I wouldn’t say it’s for lack of knowing how to deal (with it), it’s just the challenge of not having a sort of a standard upfront approach prepared to go up front. And I don’t say politics. I don’t want to point fingers at all in this.”

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How Long Will We Be Dealing with COVID-19?

Ferris mentioned reading about a poll asking physicians when physicians are expecting to be “on top of or ahead of COVID-19.” Ferris related that 50% of physician respondents are expecting that we won’t be on top or ahead of COVID until June of 2021.

Dr. David shared some other insight from his organization:

“Our projections are that we’ll be dealing with a pandemic situation probably into the fourth quarter of next year (2021) simply because the production and distribution of effective vaccines – and of course the early trials are encouraging – but it’s still a monumental undertaking. And also, we still don’t know the issues about long-term effectiveness (of any vaccine). There’s still a lot of volatility around that.” 

“It seems like 2020 has been a decade. We’re finally in August and so in addition to dealing with an ongoing pandemic, we’ll have seasonal viruses and seasonal respiratory infections starting to come into play. Tell us a little bit about how you think it’ll affect frontline practices particularly with respect to testing strategies and recommendations for families.”

Dr. Jason countered:

“The question is: what do states do at this point in terms of making requirements that some of the school-age kids must meet to even participate? 

I think New York already came out with the mandatory testing; I think California also as well. There’s certainly been a lot of confusion. There are factors that – as you point out – variables that if kids aren’t in school how does that affect exposure rates that we’re not going to project the uncertainty as a provider. I think that you’re presented with where folks are coming in is certainly so dependent upon where our testing capabilities are. And how much better knowledge we have. And how quickly folks can respond to that. And that’s why it’s very difficult. 

It gets back to the uncertainty of how quickly these conditions continue to evolve and to what extent we’re able to get better information. There seems to be a lot of people working very hard at it but there’s just so much variation in the testing and so I think it’s going to be particularly hard for providers to make that (decision) but there’s just still a lot of uncertainty about what those actual prevalence rates are going to be with the different conditions. 

I’d also ask, if kids aren’t in school, how does that affect the general trend of seasonal viruses?”

Part 2 Coming Soon – More COVID-19 Insight from Physician Executives

In the next post of this three-part series, highlights and details on the following topics from the informal discussion with Dr. Diloreto, Dr. Johanna Vidal-Phelan, and Dr. Jason Woo will be shared:

• COVID-10 Vaccines & Importance of Fall Flu Shots
• Avoiding Other Illnesses or a Different Pandemic – Maintain Immunizations
• Vaccinations for Underserved Populations – Messaging is Key
• The Change to Telehealth: New Opportunities for Providers to Connect with Patients
• Rethinking the Healthcare Supply-Chain – PPE as a Matter of Trust

Live, Interactive Follow-On Chat and Q & A – October 13th

For more detailed information on the topics raised in this series of posts and for a chance to interact with and ask questions of these physician executives, join us on October 13, 2020, at 11:00 am PT/2:00 pm ET for a live, interactive follow-on chat and Q & A opportunity.

The physician panelists will provide additional insight on what’s changed, what’s remained the same, and what may be expected this fall and going into 2021. Questions and requests for additional information shared by registrants prior to and/or during the live chat will be fielded by the panelists.

Reserve your seat and submit your questions and comments today!Be sure to take advantage of this unique opportunity to learn more about what’s presented in this post – and please share it with your associates. And if you are not a subscriber to our newsletter, consider joining 5000+ other healthcare leaders, change-makers, and industry participants and subscribe today!